Editor's Memo

For this issue of Advances in Pulmonary Hypertension, we are examining the delivery of care to pulmonary arterial hypertension (PAH) patients and the development of PAH/Pulmonary Hypertension (PH) Centers of Excellence for improving that care. With a disease such as PAH—in which the numbers are relatively small, but the consequences of poor or fragmented care are potentially huge—this is an extremely important topic.

I thank Murali Chakinala for serving as Guest Editor for this issue; he has assembled an outstanding group of contributors and has covered this subject exceedingly well. I think one of the more interesting aspects of this issue is the difference in PAH/PH care and treatment between countries in Europe and the United States. The true centralization of PAH/PH care in the UK and France is clearly different from that currently available in the United States: is it better or is it more limiting? One could argue that, in a rare disease, limiting who can see, diagnose, and treat PAH/PH patients engenders better care for such a complex illness, promotes standardization of care, and prevents treatment of inappropriate patients. On the flip side, one could argue that having such a centralized system allows some patients with the diagnosis to be missed; forces many to travel a distance for care and treatment; and can thus be inconvenient and often cumbersome. There are obviously pluses and minuses to both systems: we want you to read this issue with an open mind and consider the possibilities. However, the development of Centers of Excellence for PAH/PH in the United States may be perceived as a tacit acknowledgment that the European system is a better overall way to manage rare diseases. Murali and I hope you enjoy reading this issue and that it compels you to contemplate what is the best way to care for these complex patients and work toward achieving that goal.